Mouth gag with anaesthetic tube for surgical use



S. F. SCINTA Dec. 21, 1954 MOUTH GAG WITH ANAESTHETIC TUBE FOR SURGICALUSE 2 Sheets-Sheet 1 Filed March 7, 1952 INVENTOR- BY: Q I l @rnqy 1954s. F. SCINTA 2,697,432

MOUTH GAG WITH ANAESTHETIC TUBE FOR SURGICAL USE Filed March 7, 1952 2Sheets-Sheet 2 T Z3 I/ 14 Ill l VIIIIIIIIIIIIIIIII/IIIIIIIIIL MOUTH GAGWITH ANAESTHETIC TUBE FGR SURGICAL USE Silas F. Scinta, Pittsford, N. Y.

Application March 7, 1952, Serial No. 275,336

9 Claims. (Cl. 128-12) The present invention relates to surgery and moreparticularly to appliances for positioning and maintaining a patient ina favorable position during a surgical operation, and the invention hasfor its broader object to provide a simple, elficient, and convenientso-called gag for maintaining a patients jaws widely opened for freeaccess to the oral cavity and the throat during adenoidectorny,tonsillectom, and other throat operations, this application being acontinuation in part of a prior application filed by me deptember 7,1951, Serial No. 245,466.

Gags of this character heretofore used have usually made contact withthe upper teeth of the patient and entailed certain hazards for thelatter, particularly those that are young or elderly. In the case ofchildren, especially those around the age of 6 to 8 years, where thesecond "entition is fully developed, the contact of the gag hassometimes caused the teeth to be pushed out, with resultingdisfigurement, while in adult cases in which the upper and lowerdentitions have been lost and nothing remains but bare, sensitive, andsmooth gums, the resulting irritation is painful.

It is therefore a further object of this invention to provide a gag thatwill escape contact with the upper gums or teeth and will give a greaterdegree of present and ensuing comfort to the patient whileafi'ording thesurgeon a better view of the throat and greater clearance in the area ofhis activities in the oral cavity.

Other objects of the invention relates to improving the tonguedepressing means that also holds the lower jaw widely articulated and toimproved means connected therewith for introducing a flow ofanaesthetic, either generally or directly, to the region with which theoperation is concerned. In this connection, the invention contemplatesthe provision of a combined tongue depressor and anaesthetic conductingline that will least obstruct the open mouth of the patient and give asmuch freedom as possible to the motion of the surgeons hands andinstruments.

Provision is further made for a quick-detachable nozzle that establishesconnection with the anaesthetic conducting hose, which nozzle comes awaywith it but may be also quickly applied to the gag and adjusted to anycon venient angular position.

' These and other desirable objects may be attained in the mannerdisclosed as an. illustrative embodiment of the invention in thefollowing description and in the accompanying drawings forming a parthereof, in which:

Fig. l is a front elevation of such surgical mouth gag;

Fig. 2 is a side elevation thereof;

Fig. 3 is an enlarged section on the line 33 of Fig. 1;

Fig. 4 is an enlargedsection on the line 4-4 of Fig. 1;

Fig. 5 is an enlarged, fragmentary front view corresponding to Fig. lbut illustrative of different adjustments of the anaesthetic connection;

Fig. 6 is a top plan view;

atent i Fig. 7 is a side view of the upright stern and tongue sectionthrough the region of the joint between the anaesthetic tube nozzle andthe stem.

The same reference numerals throughout. the several views indicate thesame parts.

It is here stated that, while recently several techniques have beenpracticed in the tonsil'and adenoid operation including theTrendelenberg position in which the patient or subject is substantiallyinverted, such terms as upper and lower as used in the followingdescription and in the claims apply when the subject isv in an uprightor normal sitting or standingposition.

Referring more particularly to the drawings,xthe main element of theillustrated device consists of a buccal mask in the form of a loopincluding upper and lower gen orally horizontal portions 8 and 10,respectively, and two side portions 12 and 14 connecting therewith. Infact, in the preferred form shown, the loop is composed of a continuousbar of round metal. The lower portion 10 thereof and the greater part ofthe side portions 12 and 14 thereof are of a uniform maximum diameterbut the upper extents of the latter as wellas the upper bar 8 aregradually attenuated or tapered down to a substantially smaller diameternear the center of the upper bar or portion 8, for a purpose hereinafterexplained.

Secured to the center of the. lower portion 10 is a depending post 16 ofa channel form having on its rear side a pair of inturned side flanges17 to produce a guideway 18 (Fig. 3). Slidably supported for verticalmovement in this guideway is the fiat stem 20 as an angular downwardextension of a rearwardly projecting and downwardly curved tongue.depressing blade 22. The extension 20 is provided with a series of stopteeth 24 in the manner of a rack or ratchet bar. Cooperating with theseteeth is a pawl or ratchet lever 26 having intermediate rearwardlyextending ears 28. throughwhich it is pivoted at 30 to similar forwardlyextending ears 32 on the post 16. The nose 34 of the pawl reaches theteeth 24 through an opening 36 in post 16v and is normally urged toengagement therewith by a leaf spring 38 riveted at 40 to a finger portion 42 of the pawl lever. The lower faces of the individual teeth 24are preferably. inclined, so that the stem 20 will ratchet downwardlywithout releasing the finger piece 42, but the stem cannot move upwardlyuntil the finger piece 42 is moved to raise the pawl 26 from the teeth.

The lower end of the post 16 is equipped with a forwardly and downwardlyprojecting finger rest 44 while the lower projecting end of theprotruding stem 20 is providedmwith a rearwardly and upwardly projectingfinger rest In positioning the gag, through the mechanical arrangementslast described, the loop of the mask is applied from the frontagainstthe subjects distended jaws with the tongue blade 22 lying uponthe tongue and extending toward the base thereof and depressing andconfining it from above. The post 16 is frontal against the lower jaw orchin and the ratchet adjustment is manipulated appropriately accordingto size, child or adult. It is here that the reactionary contact withthe upper jaw provided by the present invention functions. At the centerof the attenuated loop portion 8 directly above the post 16 is providedan upwardly extending rest 48 that is inserted behind the incisors andthe gum formation or process whether or not the incisors are present andso that it rests against the hard palate or roof of the frontal oralcavity. The two jaws are thus locked in the desired extended positionsto give the surgeon and his assistants a wide view of the oral cavityand throat and a maximum of room for his manipulations while the patientor subject is confined against his natural physical reactions andmovements in a most painless manner both during and after the operation,with injury to upper teeth and gums non-existent or reduced to aminimum.

In the present embodiment, the rest 48 is provided by an upwardundulation or arch in the attenuated center of the upper portion 8 ofthe loop which is preferably covered with a rubber or similar softcontact sleeve 49, the formation as shown being best suited to theconformation of the human upper jaw structure in the region referred to.Preferably the arch is inclined rearwardly for this purpose as bestshown inFigs. 2 and 6. As shown in the same figures and also in Fig. 6,the side portions 12 and 14 of the mask loop are offset rearwardly in asemi-circular curve to approximate the contour of the checks of thesubject in harmony with which theupper and lower portions 8 and 10 ofthe loop are given also a rearward sweep (Fig. 6). This carries allparts of the appliance as far removed as possible from obstructing thesurgeons view and the use of his hands in manipulating his instruments.

Affixed permanently to the top of the tongue depressor blade 22 andextending from front to rear is an anaesthetic delivery tube 50 ofmetal, the forward end of which dips through the depressor blade at 49aand thence through the stem 20 at 50 (Fig. 11) to terminate at 52 flushwith the front face of said stem and thus not interfere with its slidingmovement in the guide post 16 or its complete removal in a downwarddirection therefrom. The said portion 49a of the tube that bridges theangle between the post 20 and the tongue depressing blade 22 is soslight in extent that it practically conforms to the curvature of thepatfents lower lip if it in fact touches it at all and hence can impartno damage or discomfort thereto. The rear part of the tube 50 followsthe curving contour of the blade 22, and is rather flattened asindicated in Fig. 10, so as to be of less thickness and less obstructionto the work of the surgeon. At its extreme rear end it is cut offobliquely as at 54, to provide an exit orifice 56 from which theanaesthetic may issue into the oral cavity or throat of the patient. Thesaid forward termination 52 is in the form of an inwardly tapered socketthat is adapted to receive the similarly tapered conical nipple end 58(see also Fig. 9) on a nozzle ppe 53) provided with a fitting 62 toreceive and retain the terminal of the anaesthetic feed tube shown indotted lines and indicated at 64 in Fig. 6. This nozzle has africtional, jam or wedging fit in the socket sufficient to retain it forpractical purposes yet permitting it to be swung at will between thevarious full and dotted line positions of Figs. 1 and as conveniencedictates.

To eliminate the possibility of traumatic contact with the lower lip ofthe patient, the front end of the tube 50 is not carried laterally overthe side edge of the tongue blade 22, as is done with certa'n priortongue depressors, but continues straight forwardly along the centerline of the tongue blade, and because of the much lower andangularlydepressed as well as forwardly offset possible adjustments of the nozzlefitting 62, the anaesthetic feed tube is always quite removed from theentire field of operation. The front end of the tube steps just to therear of the plane of the front face of the stem 29 as above described,so that the anaes hetic tube does not inierfere with complete removal ofthe tongue depressor parts 29, 22 by downward movement along theguidew'y 18. Thus the tongue depressor may be removed entirely from themain frame of the mouth gag and may be real 'ced by a difierent tonguedepressor havng a longer or shorter tongue blade 22, depending on thephysical characteristics of the patient. The lateral edges of the tonguedepressor, at the angle where the stem part 20 joins the blade part 22,are notched out as indicated at 66, so that these lateral edges willclear the flanges 17 of the guideway when the tongue depressor is moveddownwardly for complete removal.

It may be noted that the three part construction of carrying post,detachable stem and detachable nozzle lends itself to easy and thoroughcleaning and sterilization.

It is seen from the foregoing disclosure that the above mentionedobjects of the invention are well fulfilled. It is to be understood thatthe foregoing disclosure is given by way of illustrative example only,rather than by way of limitation, and that without departing from theinvention, the details may be varied within the scope of the appendedclaims.

What is claimed is:

l. A mouth gag appliance for surgical use, comprising a frame having anupper portion adapted to enter the mouth of a wearer and exert upwardpressure therein, and a lower portion having a depending post forming aguideway for a movable tongue depresser blade, said tongue blade be'ng'provided with a longitudinally extending anaesthetic conductingpassageway lying substantially along the center lineof said tongue bladeand delivering to the rear and terminating at the front rearwardly ofthefront face of the post.

2. A mouth gag appliance in accordance with claim 1,

in which the said tongue blade has at its forward end a stem slidablevertically in a guideway in said post and the anaesthetic conductingpassage terminates at the front face of the stem so as not to interferewith the movement of said stem in said guideway.

3. A mouth gag appliance in accordance with claim 2, in which there isfurther provided a detachable laterally swingingly adjustable supplytube attachfng nozzle mounted on the stem and communicating with theforward terminal of the conducting passage.

4. A mouth gag appliance in accordance with claim 3, in which thedetachable nozzle is elbow-shaped, the forward terminal of theconducting passage is in the form of a tapered socket and the rear endof the nozzle is shaped to frictlonally engage therein with a jam fitthat supports the nozzle but permits it to swing angularly upwardly,downwardly and sidewise.

5. A mouth gag tongue blade comprising a vertical guide portion and arearwardly extending tongue engaging portion connected to said guideportion at the upper end thereof and making approximately a right anglethereto, and an anaesthetic conducting tube lying throughout its entirelength substantially in a plane passing along the center line of saidtwo portions, said tube extending along the upper surface of said tongueengaging portion from a point near the rear end thereof to a pointrearwardly of and near the junction of said tongue engaging portion withsa.'d guide portion and thence extending obliquely downwardly throughsaid tongue engaging portion and across the angle between said twoportions and terminating substantially flush with the front face of saidguide portion.

6. A construction as defined in claim 5 in which said anaesthetic tubeat its forward end has a tapered socket for removably receiving atapered connecting nipple for supplying anaesthetic to said tube.

7. A mouth gag for surgical use, comprising a continuous loop having alower cross bar adapted to extend across the front of the face of thewearer in the vicinity of the wearers chin and an upper cross baradapted to extend across the face of the wearer in the vicinity of theupper lip and connecting portions connecting the upper bar and the lowerbar to each other at opposi;e sides of the gag, and a tongue depressorblade .tdjustably connected to said lower bar and adapted to enIer themouth of .he wearer and press downwardly on the tongue, said upper barextending from both ends l-aterally toward the center in a position toenter the mouth close to the upper teeth rearwardly of the incisors andwithout mak'ng any substantial pressure-causing contact with saidincisors, said upper bar after passing inwardly beyond the teeth thenextending upwardly to form a rest p rtion at an elevation substantiallyabove those parts of the bar which pass into the mouth and at a locationnot taterially resrwardly from said parts which pass into the month,said upper bar be'ng so shaped that said rest portion will engage andpress upwardly on the hard palate of the roof of the mouth of the wearerimmediately above the gums of the upper incisor teeth.

8. A month gag for surgical use, comprising a looplike frame having anupper bar and a lower bar adapted to extend across the front of the faceof the wearer of the gag, a tongue depressor blade adjustably connectedto said lower bar and adapted to enter the mouth of the wearer and pressdownwardly on the tongue, and means on the upper bar substantiallycentrally thereof for engaging the hard palate of the roof of the mouthof the wearer immediately above the gums of the upper incisor teeth topress upwardly on said hard palate wh'le maintaining said upper bar outof pressing contact with the upper incisor teeth of the wearer.

9. A mouth gag for surgical use, comprisinga looplike frame having anupper bar and a lower bar adapted to extend across the front of the faceof the wearer of the gag, and a tongue depressor blade adjustablyconnected to said lower bar and adapted to enter the mouth of the wearerand press downwardly on the tongue, said upper bar being characterizedby a substantially horizontally extending central rest portion to engageand press upwardly on the hard palate of the roof of the mouth of thewearer immediately above the gums of the upper incisor teeth, outerportions of the upper bar being adapted to extend laterally andhorizontally into the mouth at elevations substantially below saidcentral rest portion so as to avoid any substantial upward pressure 5 6on theh teeth, saicl:l upger cliaar thence curving upwacii'dbll FOREIGNPATENTS from e inner en s o sai outer portions on a gr'a' ua curve andmeeting the respective ends of said central rest g ig g portion at anabrupt angle. "f

5 OTHER REFERENCES References the file Patent 1938 Catalog, Mueller &Co., Chicago, page 119, Fig.

UNITED STATES PATENTS A6695. (Copy in Div. 55.)

Number Name Date 1,388,421 Forgrave Aug. 23, 1921 10 2,476,675 McIvorJuly 19, 1949

